Neurophysiological InatraOperative Monitoring (IOM) is an important procedure to reduce morbidity due to unexpected conditions developed during surgical manipulation. This procedure includes monitoring high-resolution, close-up video of the surgical field, analyzing simultaneously recorded neurophysiological data, and interacting with the neurosurgeon in cases where operative strategies need to be modified to avoid postoperative neurological deficits. IOM is traditionally performed within the operating room in medical centers where experienced neurophysiologists are available. In regional hospitals this monitoring is often difficult to perform because of the lack of experts. Over the years we have been studying multimedia remote IOM systems capable of transmitting neurophysiological data, voice, and images through the Interact, However, transmission of digital video with an acceptable quality for IOM is still a problem, even when a broad band Internet connection is utilized. The primary reason is the lack of a high-performance video compression algorithm adapting to the special features of IOM video. We will form a research team consisting of experienced electrical engineers, neurophysiologists, and neurosurgeons to attack this problem. We will develop a special-purpose video compression algorithms that minimize the bandwidth requirement. We will also develop new methods for synchronization and integration of the multimedia data for remote IOM. We will construct a prototype system capable of providing high-quality IOM service in rural regions within a 200-mile radius of the University of Pittsburgh Medical Center.